Providence Telemedicine Network Around the clock, around the region, our specialists are with you when every minute counts.
Telemedicine brings our specialists to your hospital It is exciting to report that Providence Health & Services has expanded its successful telestroke network to treat other conditions, including critical care and beyond. Providence Telemedicine Network is vital to Providence s vision of providing clinical expertise to our partners in outlying communities. This program provides your community access to skilled specialists while allowing your patients to be cared for close to home. This service is especially important as our partners look for ways to efficiently manage the health of the communities they serve. It s vital that community providers remain strong and independent. Our goal is to partner with providers in disease prevention and treatment, and to maximize the clinical expertise provided locally. We welcome the opportunity to be the provider of choice for tertiary and quaternary services not available in the local community. We look forward to advancing telemedicine further, and to developing dynamic relationships with providers throughout the region. Tom Lorish, M.D. Chief executive, outreach, Providence Health & Services-Oregon 3
While medically necessary in many situations, transfers create a myriad of challenges, including separating the patient from family and friends. Telemedicine allows us to keep more patients in their own community. David Hotchkin, M.D. Medical director, Providence Telecritical Care Pulmonary critical care physician, The Oregon Clinic 1
Providence Telemedicine Network How your hospital and community benefit Providence Telemedicine Network provides your hospital s physicians and patients access to experts and specialized services not otherwise available. Advanced videoconferencing systems allow Providence specialists to be in the room with your provider, helping to evaluate patients and consulting on diagnosis, treatment or appropriate transfer. Our goal is to help you enhance care in your community while improving your hospital s financial performance. We strive to keep treatments, rehabilitation and other care local and to keep your patients near their family and friends. If a higher level of care is necessary, we offer comprehensive tertiary services for complex cases. With 24-hour eicu, I go home at night knowing my patients are being closely watched and cared for and I don t have to be on call. It s also extremely valuable to have a board-certified intensivist to confer with whenever I need to. Andrea Kielich, M.D. Hospitalist Providence Seaside Hospital This partnership will provide your hospital with: n Access to clinical expertise and advanced services to ensure the best possible outcomes n Shorter stays in your emergency department n Tools and support for protocols, processes and quality improvement n Increased provider satisfaction and retention n An enhanced reputation and goodwill n Marketing and public relations assistance n Access to research and clinical trials n Reduced call costs and physician hiring n Smooth and timely transfer of patients when appropriate As part of our telemedicine network, you will benefit from staff training, including CME and CEU credit opportunities, collaboration on resources and community education, and a true partner in Providence and our network of physicians. Providence Health & Services, Oregon Region, ranks in the top 10 on IMS s list of the most integrated health care networks. 52
Your community benefits from the Triple Aim The Triple Aim is part of Providence s strategic road map to ensure we make decisions that help us deliver the kind of care our communities need. Telemedicine is helping to achieve these goals through: n Affordability: Lower cost by keeping care local n Experience: Improved access to specialists n Community health: Improved outcomes Building on telestroke successes We are making great strides toward enhancing stroke care and reducing death and disability caused by stroke. Our telestroke services provide 24-hour access to stroke neurologists and have a dedicated team committed to partnering with community providers to improve care. Early results at Providence Telestroke Network hospitals show: n A 13-fold increase in stroke treatment rates n An average response time of 4 minutes, 24 seconds n An average 38 percent reduction in transfer rate 18 months after implementation Education and training lead to improved community health We help hospitals improve their stroke care and meet national quality guidelines by providing all levels of stroke care training and education to EMS providers as well as to hospital providers and staff. This training gives providers the knowledge and confidence to keep appropriate patients in their care, minimizing unnecessary transfers and reducing costs to patients, their families and the hospital. We also partner with network hospitals to provide community education at seminars and community health fairs to raise awareness of stroke signs and symptoms. Telestroke is excellent. Having immediate access to a stroke neurologist who can help read a brain CT and advise on using a thrombolytic makes a lot of sense. Philip Chadwick, M.D., Emergency physician Providence Hood River Memorial Hospital 63
How telemedicine works A walk-through using telestroke as an example Your hospital s role n An emergency physician evaluates the patient and determines if a telestroke evaluation is needed. n The telestroke mobile unit is moved to the patient s bedside. n The physician, patient and family members speak directly to the telestroke neurologist. n Emergency staff confer with the telestroke neurologist to determine the best course of treatment, including admission or transfer, if necessary. Certain medical conditions may call for different forms of inpatient and outpatient telemedicine. For illustration purposes, let s focus on acute stroke. An on-demand remote consultation with Providence Stroke Center begins after the patient arrives at your hospital. Connecting via InTouch Health s Control Station and a secure Internet connection, a Providence stroke neurologist can remotely access the mobile unit in your emergency department, speak with your physicians, review patient records and diagnostic results, examine the patient and talk with family members to help determine the best course of treatment. Providence Stroke Center s role n We provide rapid, all-hour access to a highly experienced stroke neurologist. n The telestroke neurologist examines the patient remotely and reviews data and CT scans to determine the presence or severity of stroke. n The telestroke neurologist performs a formal consultation and confers directly with your physicians, the patient and the family to determine the best treatment plan. n The telestroke neurologist provides consultation on follow-up treatment throughout recovery, as needed. n If the patient requires transfer, the Providence Transfer Center is available 24 hours a day for immediate assistance. 74 4
Getting started Telemedicine begins with telestroke With stroke, time is brain. The faster patients can be diagnosed and treated, the better their outcomes. In many communities, patients who could benefit from tpa do not receive it because providers are reluctant to provide therapy without access to a consultation. This is why we begin telemedicine with our stroke services, providing 24-hour access to stroke neurologists and training to improve local care. We use state-of-the-art technologies that are userfriendly, readily available, reliable and secure, resulting in a network that is easy to deploy, operate and maintain. With technical support from InTouch Health, we will provide your hospital staff with comprehensive education and training for a telestroke patient examination. Community hospital requirements: n Emergency room with wireless Internet access n Teleradiology connection (can be provided if needed) n 24-hour laboratory testing capabilities n Activase in-servicing and education provided by Genentech in collaboration with InTouch Health and Providence s telestroke coordinator Our team will continue to support you through: n Ongoing hospital staff education, training and support by a telestroke neurologist and nurse coordinator and from InTouchHealth n Development of quality reports and key statistics to monitor and improve patient care, as well as continuous performance improvement of the telestroke system n CME and CEU credit opportunities n Stroke experts available to present to physicians, clinical staff or members of your community In addition to telestroke, your hospital may opt into any of Providence s other telemedicine services. Details on available services are enclosed at the back of this booklet. n 24-hour CT scanner n Pharmacy that stocks Activase (alteplase, or tpa ) Before implementing telestroke, our team will provide: n A technical assessment and a comprehensive implementation plan aligned with your facility s requirements n InTouch Health RP-7 or RP-Lite remote-presence system for your hospital n Physicians, nurses and hospital staff training to review and practice the acute stroke management protocol with Providence Stroke Center experts n Several mock patient consultations via telestroke to practice quick and accurate activation n Implementation and training provided by InTouch Health s team of engineers, clinicians and account managers One number 24-hour telemedicine consult and transfer line: 888-777-9599 Access all Providence Telemedicine Network services, including stroke and critical care, with one easyaccess line. If a transfer is necessary, the consulting physician will guide Providence Transfer Center to arrange bed placement, transportation and guest services. 5
Telemedicine FAQs How much does Providence Telemedicine Network cost? There is no fee for nonprofit hospitals to access stroke services through Providence Telemedicine Network. Fees may vary for additional telemedicine services. How much does the specialist s consultation cost the network hospital? There is no fee-per-consultation for hospitals subscribed to Providence telestroke services. Fees may vary for other telemedicine services. How does billing work? The consulting specialist may bill the patient or the patient s insurance for the consultation. Your network hospital will bill for emergency department care as usual. What are the Medicare and Medicaid reimbursement policies for Providence Telemedicine Network? State law requires that all Oregon health benefit plans reimburse providers for appropriate services provided through telemedicine. How does the telemedicine system protect patient confidentiality? Telemedicine is HIPAA-compliant. Site personnel are responsible for obtaining normal patient care consent and HIPAA documentation. Providence uses a HIPAA-secure virtual private network when transmitting any patient health information. How quickly can I get a consult? Providence stroke experts are available 24 hours a day, seven days a week for telestroke consults, and usually respond within five minutes. Please see enclosed program sheets for details on other services and contact information. What happens if the telemedicine equipment fails? In that unlikely event, technical support is available 24 hours a day. If technical issues cannot be resolved immediately, the consulting physician will complete the consultation over the phone. Is your goal to transfer as many patients as possible to Providence? No. On the contrary, our goal is to partner with network-hospital physicians and staff to keep patients in their local hospitals whenever possible. Telemedicine often is a method for rapidly triaging your patients and meeting the most up-to-date treatment guidelines. 96
Am I obligated to send my patient to a Providence hospital? No. Using Providence Telemedicine Network does not obligate your hospital to send patients to Providence. If a network hospital wishes to transfer a patient to Providence, then the consulting physician will guide Providence Transfer Center to arrange bed placement, transportation and guest services. Providence Transfer Center can be reached 24 hours a day at 888-777-9599. If we join Providence Telemedicine Network are we obligated to use the service? The network hospital physicians and staff may choose to use the telemedicine system whenever they deem it necessary. What if our hospital s emergency physician disagrees with the telemedicine consultant? The final decision for the patient s care always belongs to the bedside physician. There is no obligation for the network hospital to follow the recommendations of the consulting physician. Are there liabilities associated with Providence Telemedicine Network? The liabilities are the same as if the consultation were performed in person. When it s 2 in the morning and you re in the intensive care unit with a patient, it s easy to feel alone like you re the only person between that patient and death. It s really nice to have somebody backing you up, whether it s to let you know you re doing the right thing or to recommend sending your patient to Portland. It s reassuring. Gary Regalbuto, M.D. internal medicine Providence Hood River Memorial Hospital 10 7
Contact us Providence Telemedicine Network 9135 SW Barnes Road, Suite 363 Portland, OR 97225 503-216-1055 telemedicine@providence.org www.providenceoregon.org/telemedicine Transfer center and consult line: 888-777-9599 With Providence Telemedicine Network, I can consult with local physicians to provide expert stroke care and potentially lifesaving treatments to patients regardless of where they live. Nicholas J. Okon, D.O. Medical lead Providence Telestroke Services 8
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Our Mission As people of Providence, we reveal God s love for all, especially the poor and vulnerable, through our compassionate service. Our Core Values Respect, Compassion, Justice, Excellence, Stewardship Providence Telemedicine Network 9135 SW Barnes Road, Suite 363 Portland, OR 97225 503-216-1055 telemedicine@providence.org www.providenceoregon.org/telemedicine Transfer center and consult line: 888-777-9599 121087 SAB 10-12